The term pulmonary fibrosis should be confined
to cases which arise apart altogether from the action of the tubercle bacillus. This disease may
be due to a variety of causes, but the one special - ly considered is that form which occurs in stonehewers. It is due to the inhalation of dust particles, and its onset is often aided by improper
diet, alcoholic habits, and unhygienic home surroundings. As a rule the patient has been pre - viously healthy, while the family history is uaually
free from any tendency to pulmonary disease. The
critical epoch in the life of a stone -hewer is
between the ages of 35 and 40, and no workman should
continue at this trade after the age of 35.
Pulmonary symptoms are not always observed at
the onset of the disease. Dyspepsia and general
cebility are often more prominent than cough and
dyspnoea. There are three stages, that of onset
in which the patient can continue at work with comparative ease, that of progress in which he works
under difficulty, and that of complete breakdown in
which he is compelled to leave off work entirely.
The patient rarely lives beyond the age of 40, and
probably most deaths occur between the ages of 39
and 42 years. Death is often the result of
secondary tuberculous infection, of heart failure,
or of some other complication such as bronchiectasis.
Death may either occur suddenly or the patient may
be confined to bed for some days or weeks before
the end.
The pro gnosis.depends to a large extent on the
ability of the patient to leave off work before the
disease has become too far advanced. In any particular case the prognosis will be influenced by
the extent of the fibrosis, by the nature and severity of the complications, by the intensity of
the dyspnoea, and by the general environment of
the patient.
The diagnosis depends partly on physical signs
and partly on symptoms which are more or less
definite and characteristic. In every case the
urine and sputum should be carefully examined and a blood count made. The invasion of the lung by
tuberculous disease should be recognised as early
as possible and this may be done by examination of
the sputum and larynx, as well as by the Rontgen
rays and by the use of tuberculin. The differential.
diagnosis of pulmonary fibrosis as it occurs in
stone -masons is not usually difficult, but certain
other conditions may resemble it very closely, and
accordingly care must be exercised in weighing the
results of the physical examination of the patient
and in interpreting the general symptoms in any
particular case.
Treatment may be prophylactic; otherwise
measures must be adopted which will relieve the
symptoms and tend to prolong the life of the patient.
General hygiene, good food, fresh air, moderate
exercise, judicious rest, and certain drugs, especially strychnine, ichthyol and iodides, are
all calculated to meet the exigencies of the case.
Complications must be treated as they arise, and
attention ought specially to be given to the heart
which should be carefully examined from time to
time.
